Minoxidil 5% Spray is the only over-the-counter medication licensed as a treatment for male pattern baldness, which makes it a popular choice. Originally licensed as a hair loss treatment in the 1980s, it has decades of clinical research and real-world use to back it up as a genuinely effective solution – stopping hair loss in 84% of users.
But that doesn’t mean it works for everyone. Some people stop using it even when it seems to be helping, usually because applying twice a day becomes difficult, it irritates their scalp, or they’re worried about keeping it away from pets (minoxidil is toxic to animals). Others stick with it for months and follow the instructions perfectly yet still feel like their hair isn’t improving.
More recently, researchers have come up with a theory to explain why there may be a specific group of people who simply don’t respond to minoxidil spray. The reason comes down to the amount of a particular enzyme present on the scalp. If someone has low levels of this enzyme, the spray may not work for them - but interestingly, minoxidil capsules (Oral Minoxidil) can. Since the capsules are swallowed instead of applied to the skin, they’re processed by the body differently, offering an alternative to Minoxidil Spray.
How to know if minoxidil spray is working or not
If you’re unsure whether Minoxidil Spray is doing anything for your hairline, it’s worth stepping back and considering a few things before stopping or switching treatments.
Give it enough time
Some people (the lucky ones) will start to notice results with Minoxidil Spray in as little as 3 months, but for others, it will take longer. Typically, the first signs will appear within 3-6 months of consistent, daily use. This could mean you notice less shedding than usual, new baby hairs starting to grow, or more coverage of the scalp. Because progress can be subtle, we strongly recommend taking photos before you start and then once a month in the same lighting and angle. It gives you a reliable way to spot changes that you might otherwise miss.
Make sure you’re applying properly
With Minoxidil Spray, it’s important you’re using it as directed for best results. If applied improperly, it can slow down progress.
1. Make sure your hair and scalp are completely dry.
2. Apply to your scalp, not your hair. The medication works on your hair follicles beneath the surface of your scalp, so you need to make sure the solution makes direct contact with your skin.
3. Apply twice a day, every day. Once in the morning and once in the evening. You may find it helpful to gently massage the liquid into your scalp to help with absorption.
Be aware that shedding might happen early on
It’s very common to experience a temporary increase in shedding when you first start using minoxidil, known as the ‘dread shed’.
It can be worrying, but it’s actually a sign the minoxidil is doing its job. When you’re going through hair loss, it means your hair follicles are spending more time in the telogen ‘resting’ phase of the hair growth cycle, instead of actively growing in the anagen phase.
Minoxidil helps move hairs out of their resting phase and back into the active growth phase. When this happens, older hairs are pushed out to make way for newer, thicker ones.
What to do if Minoxidil Spray isn’t working
If you’re doing everything right: you’re applying minoxidil properly, you’ve given it at least 6 months of consistent use, and you’re sure you’re not doubting due to a dread shed, it’s possible that you’re a non-responder to Minoxidil Spray. However, this doesn’t mean you won’t respond to minoxidil itself. Let us explain how that works…
Why Minoxidil Capsules might work instead
Minoxidil Spray has to be converted on the scalp into its active form, minoxidil sulphate, by an enzyme called SULT1A1. Once converted, it can help improve blood flow to hair follicles, shorten the resting phase, and extend the growth phase, encouraging longer and thicker hair.
The key point is that not everyone has enough of the SULT1A1 enzyme on their scalp. If your levels are naturally low, the spray may not convert properly, which means it might not be effective. Oral minoxidil, on the other hand, is converted into its active form by enzymes in the liver, where SULT1A1 is abundant. This has led researchers to hypothesise that people who don’t respond to the spray may still see good results with the capsule.
A 2024 study tested this hypothesis with 41 patients with androgenetic alopecia (26 men and 15 women) who were using low-dose oral minoxidil. Researchers measured the levels of SULT1A1 enzyme on the scalps of all the participants. Interestingly, they found that those that had low SULT activity on their scalp responded better to oral minoxidil. There was an 85% response rate in those with low activity, compared to 43% in those with high activity.
This is an area of ongoing, active research: the link between sulfotransferase enzymes and minoxidil is not fully understood. Until the results are replicated in a robust, peer-reviewed trial, they can be taken with a pinch of salt.
You might be wondering: if minoxidil sulphate is the active compound, why not just apply that directly to the scalp for hair growth? The reason is that the molecule is too large and not very soluble, which means it can’t penetrate the scalp effectively. If it can’t reach the follicles, it can’t work. That’s why minoxidil needs to be converted locally on the scalp (for spray) or in the liver (for capsules).
All of our blog articles are reviewed by our Medical Director before publication.
